Clinical Informatics: Practical Tools and Tips You Can Use in Your Practice. Patricia P. Sengstack DNP, RN-BC, CPHIMS. Objectives

Transcription

1 Clinical Informatics: Practical Tools and Tips You Can Use in Your Practice Patricia P. Sengstack DNP, RN-BC, CPHIMS 1 Objectives Identify at least one evidence based informatics tool that can be applied during each phase of the system development lifecycle Evaluate multiple informatics resources for potential application to one's work setting 2 1

2 Review SDLC Resources, Tools and Tips Plan & Assess Design & Build Test & Train Implement Maintain & Optimize Evaluate Agenda 3 System Development Lifecycle Assess & Plan Evaluate Design & Build Maintain & Optimize Test & Train Implement 4 2

3 Assess and Plan 5 6 3

4 The Office of the National Coordinator for Health IT: Guide to Reducing Unintended Consequences of Electronic Health Records

5 EHR Goal Setting (cont d) 9 DOQ IT EHR Goal Setting pdf/moduleiipdf1.pdf 10 5

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7 13 AHRQ s Workflow Assessment for Health IT Toolkit

8 Design & Build

9 US Department of Health and Human Services: Improving the User Experience 17 Usability Design Concepts Simplicity Naturalness Consistency Minimizing Cognitive Load Efficient interactions Forgiveness and feedback Effective use of language Effective information presentation Preservation of content 18 9

10 Usability Resources St.John, C., Designing a usable healthcare information system (2015), Chapter 3 in: Sengstack & Boicey, Mastering Informatics a Healthcare Handbook for Success. Sigma Theta Tau International, Indianapolis. Middleton, et.al., Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIAJ Am Med Inform Assoc 2013;20:e2 e8. AHRQ s EHR Usability Toolkit: A Background Report on Usability and Electronic Health Records HIMSS - Defining and testing EMR usability: principles and proposed methods of EMR usability evaluation and rating (2009) himss_definingandtestingemrusability.pdf 19 The System Usability Scale The SUS is a 10 item questionnaire with 5 response options. 1. I think that I would like to use this system frequently. 2. I found the system unnecessarily complex. 3. I thought the system was easy to use. 4. I think that I would need the support of a technical person to be able to use this system. 5. I found the various functions in this system were well integrated. 6. I thought there was too much inconsistency in this system. 7. I would imagine that most people would learn to use this system very quickly. 8. I found the system very cumbersome to use. 9. I felt very confident using the system. 10. I needed to learn a lot of things before I could get going with this system

11 Measuring Usability With The System Usability Scale (SUS)

12 23 EHR Usability Toolkit: A Background Report on Usability and Electronic Health Records

13 ISMP s Guidelines for Standard Order Sets 25 ISMP s Guidelines for Standard Order Sets

14 Test & Train 27 Testing The person who does the configuration should not be the person who does the testing Start with well developed testing scripts Consider automation of regression testing: Order Entry Clinical Documentation Preview of Reports Patient Admit/Discharge/Transfer 28 14

15 Testing Integration Testing Test Script for Barcoding Lab Specimen System 1. Physician logs into the hospital information system. 2. Physician selects the test patient. 3. Physician enters a lab order to collect a CBC + Diff. 4. Nurse logs into the barcode specimen collection application. 5. Nurse scans the patient ID. 6. Nurse verifies that CBC + Diff order is present in specimen collection application. 7. Nurse prints a label for CBC + Diff order and affixes to tube. 8. Nurse draws a sample in tube. Nurse scans a label barcode to indicate that specimen was collected. 9. Physician validates in the hospital information system that the order is updated to specimen collected status, and that date/time associated with order is date/time of specimen collection. 10. Nurse sends tube to the lab. 11. Lab scans label barcode to indicate that the specimen was received. 12. Lab performs tests with analyzer on the specimen. Results are documented in the lab system. 13. Prescriber validates in hospital information system that the order is updated to resulted, and that all results documented in lab system are visible under results view for patient. Carlson, S. (2015). Testing in the healthcare informatics environment. In Sengstack & Boicey. Mastering Informatics: A Healthcare Handbook for Success. Sigma Theta Tau International. Indianapolis, IN. 29 Testing Tools to capture issues found during testing: Consider tools to automate functional or regression testing: Order Entry Clinical Documentation Preview of Reports Patient Admit/Discharge/Transfer

16 Adopt a training model: ADDIE Analysis Design Development Implement Evaluate Training 31 EHR training is complex Everything cannot be taught in one session Training scenarios need to be relevant to the participants Consider adopting a phased approach: EHR 101 Training EHR 102 (3 to 6 months later) 32 16

17 7/9/15 Implement 33 Implementing Planning for Go-Live Small project 2 months out Larger project 4 to 6 months out Use sticky notes to develop an Activation Plan 34 17

18 Implementing Develop an Activation Check List Friday March 9, 2015 Time Start End Resource 25 Clean up Production servers (remove old databases & Logs) 60 min Tom 26 Copy/Backup Sue 27 Update Training Workstations Rubi Saturday March 10, Announce downtime 5 min Eileen 31 Disable Citrix access to scmprod 5 min Fred 32 Point user workgroup to scmmodel 5 min Tina 33 System downto users 34 Turn off SCM Batch Jobs 5 min Tim 35 Copy ES Db backup from Server 1 to Server 2 & Restore 30 min Tim 36 Run Report Query (all reports completed) 10 min Seth 37 Turn off All Services (order generation, reports, etc.) 10 min Mike 38 Start - Move backup file to Report Server 5 min Fred 39 Ensure interface queues are empty 5 min Tony 40 Delete all MLMs from prod 10 min Seth Stop traffic to system from the interface engine 41 5 min Tony 35 Implementation Go live when things are quiet (volume low) Avoid holidays when resources are out of town Check local school schedule for days off. Resources may not be available Provide at the elbow support 36 18

19 Maintain & Optimize 37 Maintain & Optimize Settergren, T. Maintaining and optimizing a healthcare information system (2015), Chapter 7 in: Sengstack & Boicey, Mastering Informatics a Healthcare Handbook for Success. Sigma Theta Tau International, Indianapolis 38 19

20 Maintain & Optimize ONC s SAFER Guides 39 ONC s Safety Assurance Factors for EHR Resilience

21 Evaluate 41 Evaluate 42 21

22 AHRQ Health Information Technology Evaluation Toolkit %20Revised%20Version.pdf 43 Evaluate

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24 47 AHRQ s Health IT Survey Compendium

25 Thank you! Questions? Patty Sengstack 49 25